Ehr Survey To: Tribal Health Directors - Npaihb
EHR SURVEYTO:TRIBAL HEALTH DIRECTORSFROM:KATIE JOHNSON, EHR INTEGRATED CARE COORDINATORSUBJECT:EHR SURVEYDATE:FEBRUARY 4, 2013Hello allEnclosed is a Medscape Survey of over 20,000 providers asking them to rank various electronicmedical records. We found the results interesting, and wanted to provide the full survey to you. Wecan discuss further at the April THD meeting, or before if you’d like.There are a couple of things to point out: VA-CPRS made the survey – which is essentially the RPMS EHR – and did verywell. In recent discussions on electronic records related to Meaningful Use that Ihad seen, VA-CPRS has been left out because VA providers were generally noteligible for the MU Incentive programs. Many have seen a decrease in productivity (26%) when moving to any electronicrecord, but a similar number of respondents (23%) reported more efficiency. Attitudes before and after adoption of an EHR did not change much in the survey –those that were in favor, mostly remained in favor of EHRs, while those that foughtit, mostly did not change their minds after one year of use. The old adage: Attitudeis everything may be at play here. The slide on web-based options with some vendors – an option particularly for ourvery small sites?503-416-3272kjohnson@npaihb.org
Total respondents: 21,202 respondents across 25 specialties Fieldwork conducted by Medscape from May 30 to June 15, 2012 Data collected by third-party online survey collection site
Electronic health record (EHR) use has reached critical mass and has become an accepted part ofmedical practice. For physicians for whom EHR is not yet a way of life, it probably will be soon.Fully 82% of respondents either currently use or are in the process of implementing an EHR."You don't need to be a weatherman to know which way the wind is blowing," said one internist.In Medscape's 2009 Reader's Choice EHR survey, only 38% of respondents were using an EHR.At that time, more than a third said they didn't have an EHR and didn't plan to get one. Famouslast words: In our 2012 survey, only 6% of respondents said they plan to remain without anEHR."Incentives have put everything on the front burners for physicians," says Ronald B. Sterling,CPA, MBA, national EHR expert, Silver Spring, Maryland, and author of Keys to EMR Success(Greenbranch Publishing). "They said to themselves, 'If the government is going to pay me to getan EHR, I can't not do it.'"
The EHR brands used by the largest percentage of respondents are Epic (22%), Allscripts (10%),and Cerner (9%). (Note: This chart represents frequency of usage, not ranking of satisfaction.)Many physicians are using EHRs other than the 17 major brands listed. The category "others"represents a large number of EHR brands, including MediNotes, SOAP Notes, QuadraMed,specialty-specific EHRs (eg, Wound Expert), and custom EHRs (ie, "hospital-developedsystem," "we wrote our own").
We asked physicians to rate their EHRs on a scale of 1 (dislike most) to 5 (like most) for 12factors: (1) easy to learn; (2) ease of data entry; (3) overall ease of use; (4) ease of EHRimplementation; (5) reliability; (6) adequacy of vendor training program; (7) vendor continuingcustomer service; (8) interactivity with other office systems; (9) value for the money; (10)physician overall satisfaction; (11) staff overall satisfaction; and (12) appearance/overallusefulness of the end product (notes, consultations, etc.)In Medscape's 2012 survey, the 5 top-ranked EHRs were Amazing Charts, Practice Fusion, VACPRS, and Medent. In Medscape's 2009 survey, the top-ranked EHRs were Amazing Charts,MediNotes, VA-CPRS, Misys (now Allscripts), and Practice Partner and eClinicalWorks tied forfifth place.(Note: The survey analysis did not weight results by number of users of each EHR brand.)
Many factors were considered in the rating of an EHR. Some vendors shone in certain areas,while others had strengths in different realms. "Easy to learn" and "easy to implement" wereamong the most important factors that respondents considered, because for most, those factorsmarked their introduction to the EHR. Readers appreciated EHRs that were more "intuitive"because they allowed users to more easily figure out aspects of operation when instructions werenot available.
Some EHRs scored fairly well in several factors but less well in the areas of vendor trainingprogram and vendor continuing customer service. Those factors can be very important becausephysicians and other users do not want to feel stuck with no one to troubleshoot problems oranswer questions after the initial installation and training take place.
A key factor was appearance/overall usefulness of the end product. An EHR ultimately needs topresent information in a way that is easy to understand, easy to work with, and is user-friendly.Interactivity with other office systems is also critical; if the EHR operates with other systems,other office functions can be made more efficient
Some EHRs are tailored for larger practices and have more options and capabilities. The choiceof EHR is heavily influenced by practice size, which also affects the amount of money availableto purchase a more sophisticated EHR system. This results in smaller practices favoring certainEHRs and larger practices choosing others.The overall satisfaction rankings for EHRs reflected this practice-size selection. Among thelarger (26 physicians) practices, top choices were VA-CPRS, Epic, e-MDs, and Medent.Smaller practices gave high rankings to Amazing Charts, VA-CPRS, and Practice Fusion.
EHRs have a profound effect on medical practices, whether positive or negative. Only 5% ofrespondents said the EHR had no discernible effect on their practice. More doctors said the EHRdecreased rather than increased productivity (26% vs 15%). Almost a quarter of physicians notedincreased efficiency (23%). About 6% said the EHR increased practice revenue. An increase inmedical errors was noted by 5% of respondents."Productivity often declines because the doctors are now doing their own record-keeping," saysSterling. "A lot of times, the doctor never really learned how to use the system correctly and isfighting the system. The system says, 'Go through these steps'; the doctor says, 'I don't like it thatway' and does his own thing. It's contingent on how well the doctor worked that EHR into thepatient model."
Physicians were about equally split between whether the EHR worsened, enhanced, or had noeffect on the doctor-patient relationship. Slightly more doctors said it had a positive effect (36%)than a negative effect (30%).Of doctors who said it had a negative impact, a whopping 82% said it was because of less eyecontact with the patient; 75% said there was less conversational time, and others gave a varietyof answers: "Frustrated MDs do not make compassionate providers," said one neurologist. "I feellike I'm treating the computer and not the patient," said a family physician. "There's more focuson documentation than on the patient during the patient visit."
Vendors have a huge impact on physicians' EHR experience. Doctors often differentiate betweenthe EHR product itself vs satisfaction with the vendor."The doctor purchased the EHR through a salesperson, and the salesperson asked all the rightquestions about operational challenges," says Sterling. "Now the job gets turned over to thevendor's implementation person, who is starting from zero again. Then, most vendors turn it overto their support staff. The support staff doesn't know anything about the doctor; they've neverbeen to your office. They try to jump into the fray, but often they don't understand the context ofyour organization and may not be giving advice targeted to your situation."Readers had mixed reactions about their vendors: "The vendors are talented people with verylittle educational training, teaching novice users who have high demands of themselves and thetrainers," said one respondent. "They are very conscientious about making improvements andcorrections," said another.
Some physician practices cried "uncle" after having a thoroughly unsatisfactory experience withtheir EHR. Others felt they had put too much time, money, training, and effort into their currentEHR; no matter how difficult their experience with it, they decided to grin and bear it rather thanlay out more money and subject themselves to more hassle.A large number of physicians say they're stuck with someone else's decision: "I'm not happy withthe EHR, but I don't have the authority to change it"; "The hospital chose it; I have no choice inthe matter." Another physician commented, "I am happy with it, but it is not certified and I haveto buy another."
"Many vendors offer both Web options and internal (installed) EHRs, and more vendors are nowoffering Web-based EHRs," says Sterling. "It's a better business model for the vendor."You'll be paying as long as you will have that product," says Sterling. "You'll end up payingmore for the Web solution, paying for the license component, than if you had paid yourself andhad installed an EHR."Still, the current financial outlay for an installed EHR is more than many small practices want tobudget for, and if no one on a small staff is particularly tech-savvy, then many practices will balkat dealing with hardware and server issues.
Costs varied greatly for practices with an installed vs a Web-based EHR. Physicians working inhospitals or large facilities often were not aware of the installation cost. Of those who wereaware of costs, the most frequent range was between 10,000 and 35,000."There is the downside of jumping in early," said one respondent. "We have colleagues locallywho paid less than half for the same product; we paid around 75,000 per doctor."Some respondents saw the costs from a more macro perspective: "The cost was 70 million forthe hospital and outpatient practices," said one.The majority of respondents replied, "I don’t know
Monthly service fees vary, and some services are free (because the Web product includes paidadvertisements to physicians).Costs vary depending on what you're getting. "In some cases, you pay for certain things up frontand separately; in other cases they fold it into your monthly fee," says Sterling. "You have to goback and look at what services are being provided. If you're getting services à la carte, monthlyfees may look cheaper but you are basically paying for everything individually. Think of the wayan airline charges: Are you really getting a less expensive ticket if you have to pay extra forbaggage and other costs?"Some respondents noted that the system was free to them, but the overall organization waspaying the service fees. "It is covered by the HMO because we are exclusive with them," said aninternist.The majority of respondents replied, "I don’t know."
A doctor's attitude prior to using an EHR was the most important factor in predicting how he orshe would feel after working with an EHR.Overall, changes in attitudes after 1 year of use were fairly minor in each category, with aslightly greater percentage of doctors strongly against the EHR after using it. About 62% ofrespondents were somewhat or strongly in favor of an EHR before they began using one; 67%were somewhat or strongly in favor after using one. The percentage of those somewhat orstrongly against an EHR increased from 12% to 14%.This means that if your office will be getting an EHR, it pays to put a lot of front-side effort intogetting your office physicians and staff pumped and positive about having the system. It is likelythat however they feel in advance is how they'll feel afterward. The first year is typicallyfrustrating and difficult, with a big learning curve as the physician integrates the EHR intopatient visits.
Controversy remains over whether using an EHR will lead to more or less testing. EHRs havebeen cited as one element to help contain skyrocketing healthcare costs. Keeping patient recordsthat can be accessed by specialists and caregivers is intended to help reduce duplicative tests.However, studies have shown mixed results. A study conducted by the Cambridge HealthAlliance showed that doctors with EHRs that enable them to view patients' previous imagingresults ordered 40% more tests than those using paper records. Yet researchers fromMassachusetts General Hospital in Boston found that EHRs helped doctors avoid ordering sometests.In Medscape's survey, more than 4 out of 5 physicians said they saw no difference in the amountof tests ordered. An almost equal number said they were ordering more tests (8%) and fewertests (9%).
In primary care, there were more physicians ordering a greater number of tests when using anEHR than ordering fewer tests with the EHR. Nearly the same percentage of family physicians(14%) and internists (13%) saw no difference in the number of tests ordered before and afterusing an EHR
One goal of EHRs is to connect with other office systems and other providers and to make surethat a patient record can be accurately and easily integrated into the total system workflow.However, for almost half (46%) of respondents, interconnectivity was clearly a thorn in theirside. "The prescribing module does not interface smoothly with the rest of the system," said onerespondent. "I find that I have to log into multiple systems because the interfaces are not fullyworked out," said another. "At this point, the EHR can't connect to most labs we work with.""If you're talking about within their own offices, if the practice management system is from onevendor and the EHR is from another, they won't work well together, or the patient portal may notwork well with the EHR," says Sterling."Between practices, EHR interconnectivity is still developing. We are in the process of buildingthe highways between practices, and we don't have access to the highway yet."
Despite some widely publicized data breaches, more than three fourths of respondents did notworry about patient privacy issues related to the EHR. Those who were concerned, however,were quite concerned. One family physician said, "Being Web-based, anyone can access thepatient record with rudimentary hacking skills." "It makes it easier for staff to view patientinformation when they should not view it," said a pediatrician. "Despite firewalls, I'm concernedabout security with Web portals," said a nephrologist. "I'm told it's secure; I guess I will have tobelieve them."Health Insurance Portability and Accountability Act (HIPAA) privacy issues may also pose athreat in many practices. Many practices have not maintained or updated their HIPAA privacystatement, and there are many other potential HIPAA privacy issues.
Meaningful use refers to the measurable benchmarks doctors must meet to qualify for incentivepayments under the Health Information Technology for Economic and Clinical Health(HITECH) Act. Clearly, attesting for meaningful use has become a major goal. Three quarters ofphysicians either have already attested for meaningful use or are definitely planning to do so."Attesting is more about the way you're using the EHR than the EHR itself," says Karen Bell,MD, Chair of the Certification Commission for Health Information Technology. "Just becauseyou have a certified EHR doesn't guarantee that you'll get a payment for meaningful use, unlessyou are a Medicaid provider."
In a June 2012 report, officials at the Centers for Medicare & Medicaid Services noted that thenumber of physicians and other healthcare providers receiving Medicare and Medicaid bonuspayments for adopting EHRs was over 110,000.While incentives are clearly a draw for many physician practices using an EHR, for otherdoctors, using the EHR is the end goal itself.Why might physicians disregard the incentives? "Their EHR might not be qualified," saysSterling. "Or if they don't have many Medicare patients, they wouldn't apply. Or they may noteven take any insurance at all; they may do a lot of elective procedures."
Almost 9000 respondents offered advice for other doctors who are choosing or using an EHR.Many remarks were clearly heartfelt, some fully in favor of EHRs and others wanting to helpdoctors avoid the mistakes they made. "If the company sends a PR person instead of aprogrammer, reject the company's product," said a pediatric endocrinologist."Be aware of all the hoops, buttons, and clicks that need to be done to attain meaningful use;don't learn them after you have started (like I did)," said one respondent."Actually use a system on a 'fake' patient before deciding on an EHR. It is a totally differentanimal to hear what the EHR can do until you start entering data yourself," said an emergencyphysician. "Have a physician teach you how to use it, not an IT person," said a family physician."Bite the bullet and get it done; stop living in the Stone Age," said a family physician, whoseadvice contrasted with that of an emergency physician who simply said, “Run away!”
In Medscape's 2009 Reader's Choice EHR survey, only 38% of respondents were using an EHR. At that time, more than a third said they didn't have an EHR and didn't plan to get one. Famous . the EHR product itself vs satisfaction with the vendor. "The doctor purchased the EHR through a salesperson, and the salesperson asked all the right .
Professional EHR - An EHR catered towards small-mid sized healthcare providers, offering an easy to use interface. TouchWorks EHR - Touchworks EHR software is a product from Allscripts, a vendor that provides multi-site and specialty support as well as configurable desktop. Sunrise EHR - A comprehensive EHR system for large clinical enterprises.
EHR Replacement EHR replacement - Do it right! 1 In good company! (EHR replacement is popular) About the author. A letter from Dr. Gary. 2 Decision: Replace the EHR. Now what? 3 EHR replacement: Do it right! 4 Project manage. Manage change. 5 Select the right EHR solution. 6 Get the right EHR support at the right time.
EHR Implementation Status, 2018 5%. 18%. 19%. 28%. 13%. 16%. 2018 EHR Implementation Status. Not yet implemented. Fully implemented EHR. Less than 6 months. 6-12 months. 12-18 months. More than 18 months Of behavioral health provider organizations who purchased an EHR, 77% describe the EHR as fully implemented The majority (37%) of EHR
with this EHR. 9. This EHR enables me to practice higher quality medicine than I could with paper charts. 10. I have a good idea how much this EHR system is costing my practice. 11. This EHR is worth the expense. 12. Our EHR vendor provides excellent training and support. Survey overview: 13. I a
genomics in the EHR? Non-exceptionalist perspective: Any genetic or genomic test can be ordered from an EHR via CPOE Any genetic test report can be included in the EHR as a text document Some EHR systems (or LIS modules within an EHR): Support storage of discrete genetic findings (variants, quantitative
Tribal Chair, Robert Pino, Srt . Pauma Band of Luiseño Indians Tribal Chair, Temet A. Aguilar Iipay Nation of Santa Ysabel Tribal Chair, Virgil Perez Rincon Band of Luiseño Indians Tribal Chair, Bo Mazzetti Inaja-Cosmit Band of Indians Tribal Chair, Rebecca M. Osuna San Pasqual Band of Mi
EHR Transition Satisfaction Survey Summary Clinic: Tidwell Provider Staff 9-10 to 9-13-07 N 4/5 (1 on vacation) The patients will see the 3.00 benefit of having an EHR 3.50 The EHR will improve patient care The EHR will positively 2.00 impact my productivity 3.75 The transition process went better than I expected Strongly Disagree 1 Disagree .
ANSI A300 defines as a tree risk assess-ment: “A systematic process used to identify, analyze, and evaluate risk.” “Mitigation” is a term that I see com-monly used inappropriately. In the Standard, it is very clearly defined as the process of diminishing risk. We do not eliminate risk in trees when we perform some form of mitigation practice. We are minimizing the risk to some .
